Organization
CLARK MANOR CONVALESCENT CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK SCHNELL (PRESIDENT)
(773) 338-8778
Entity
Organization
Contact information
Practice address
7433 N CLARK ST, CHICAGO, IL 60626-1619
(773) 338-8778
(773) 764-7449
Mailing address
7433 N CLARK ST, CHICAGO, IL 60626-1619
(773) 338-8778
(773) 764-7449
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0038596
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/23/2006
Last updated
08/22/2020
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